Prostate Cancer Treatment

Treatment of localized prostate cancer

The object of any treatment is to eradicate the cancer and then heal the body. There are essentially two options which are regularly offered: surgical removal of the prostate or destruction using radiotherapy. However there are an ever-growing number of alternative treatment options which might also be suitable.

It's important that the choice of treatment program is arrived at in consultation with your doctor, the urologist and also your partner. Your doctor should explain very clearly the advantages, disadvantages, the inconveniences and indeed the risks associated with each option. You should then weigh up the implications and be very clear in your decision before proceeding with treatment.

Operating on a cancerous prostate

Unlike operating on BPH, an operation for cancer involves removal of the entire gland and the seminal vesicles. This is known as a total prostatectomy, and is carried out using one of the following methods:

• gaining access via an incision between the pubis and the navel;
• passing via the perineum; or
• coelioscopy by making a few small incisions in the abdominal wall through which the instruments pass.The operation is carried out using a camera with the surgeon following his work on a television monitor.

Time spent in hospital varies from 3-5 days for operations carried out via the perineum and by coelioscopy, to a week when the abdomen has been opened.

One month following the operation, the level of PSA measured in the body should have fallen to zero.

Radiotherapy

An alternative to surgery is radiotherapy. The long-term results in terms of healing are comparable to surgery.

Radiotherapy involves destroying the cancerous cells using energy rays. The treatment is carried out over a period of about 6 weeks, such that the doses of radiation are delivered in small quantities each day so as to minimise complications.

The main complications are essentially either cystitis (inflammation of the bladder) or rectitis (inflammation of the rectum), both usually transitary in nature, but with the potential of being somewhat incapacitating.

It is difficult to predict the repercussions on sex-life, since the rays do their work slowly over several months. However, the risk of impotence does exist.

Unlike with surgery, the level of PSA reduces much more slowly using radiotherapy, sometimes taking a year to reduce to zero.

Surgery or radiotherapy?

Which route to take depends very much upon the life-expectancy of the patient (i.e. your age and general health) and also upon your own personal considerations. The longer your lif-expectancy, the more a urologist will tend to prefer to operate, keeping the radiotherapy option in case of any future recurrence in years to come. However the risk of impotency after the operation often frighten men and therefore many prefer to opt fo radiotherapy.

From 70 years of age, radiotherapy is the method most often proposed, although it is still possible to operate.

At the age of 80 and over, men can choose to avoid an operation, in preference for regular surveillance, since at this time of life the disease develops very slowly. However, radiotherapy is possible, as is hormone treatment

Alternative treatment options

New methods for treating prostate cancer are always under development, and you might wish to discuss them with your doctor and urologist.

HIFU Ablatherm

One method is HIFU (an abreviation for High Intensity Focused Ultrasound). HIFU allows the surgeon to necrose (kill) prostatic tissue without damaging surrounding areas. This eliminates the need for incisions and general anesthesia.

The trade name for this non-invasive treatment is Ablatherm, and it is specifically for treating localized prostate cancer. The nature of Ablatherm therapy means that it is also possible to repeat it at a later date should the need arise. Mobile machines are also available, making it accessible to an increasing number of hospitals.

Curietherapy

Curietherapy is a treatment in which grains of radioactive iodine are implanted directly into the prostate, during a general anesthetic and using ultrasound monitoring. These apply a localized radiation directly to the gland, thus considerably reducing the risk of burning the rectum and bladder, as can arise with radiotherapy.

Curietherapy has also demonstrated the advantage of avoiding impotence in more than 70% of patients. However its effectiveness as a long-term treatment of prostate cancer is still being studied.

After treatment for prostate cancer

Once prostate cancer has been treated, it is crucial that regular surveillance is carried out, with follow up DRE and PSA tests at frequent intervals, to be determined by your doctor and urologist.

For a discussion of treatments applicable to advanced forms of prostate cancer, follow this link: Advanced prostate cancer treatments